A national study of violent behavior in persons with schizophrenia
A national study of violent behavior in persons with schizophrenia
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DOI：
10.1001/archpsyc.63.5.490
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发表时间：
2006-05-01
影响因子：
--
通讯作者：
Lieberman, JA
中科院分区：
文献类型：
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作者：
Swanson, JW;Swartz, MS;Lieberman, JA
背景：暴力行为在精神分裂症患者中并不常见，但存在问题。临床、人际关系和社会环境危险因素对该人群暴力行为的复杂影响知之甚少。目的：通过建立多变量统计模型，评估精神病症状和其他危险因素对轻微和严重暴力行为的净影响，研究生活在社区的精神分裂症患者暴力行为的患病率和相关因素。设计：对1410例精神分裂症患者在过去6个月中的暴力行为进行了临床评估和访谈。数据包括参加国家精神健康研究所临床抗精神病药物干预有效性试验的患者的基线评估。设置和患者：诊断为精神分裂症的成年患者从美国的56个地点参加，包括学术医疗中心和社区提供者。主要结果测量：暴力分为2个严重程度：轻微暴力，相当于没有伤害或使用武器的简单攻击;严重暴力，相当于造成伤害或涉及使用致命武器的攻击，手中有致命武器的威胁，或性攻击。任何暴力的综合措施也analysed.Results：6个月的任何暴力的患病率为19.1%，与3.6%的参与者报告严重的暴力行为。不同但重叠的风险因素与轻微和严重的暴力行为有关。“积极”的精神病症状，如迫害意念，增加了轻微和严重暴力的风险，而“消极”的精神病症状，如社会退缩，降低了严重暴力的风险。未成年人暴力与共同发生的药物滥用和人际和社会因素有关。严重的暴力行为与精神病和抑郁症状，儿童行为问题，和victimization.Conclusions：特定的集群的症状可能会增加或减少精神分裂症患者的暴力风险。社区治疗中的暴力风险评估和管理应侧重于临床和非临床风险因素的组合。
Context: Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood.Objective: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence.Design: A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness.Setting and Patients: Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers.Main Outcome Measures: Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed.Results: The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. "Positive" psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization.Conclusions: Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.